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is $200 the new minimum in psych?

randomdoc1

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that doesn't sound right. for a 40hr work week and if you work 50 weeks a year that's 400k base with no benefits.
Albeit, 180/hr is very feasible in private as an independent contractor with half hour visits psychtherapy add on code. If you do 15 min med checks, then i guess, yes, 200/hr can be a going rate.
 
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clausewitz2

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that doesn't sound right. for a 40hr work week and if you work 50 weeks a year that's 400k base with no benefits.
Albeit, 180/hr is very feasible in private as an independent contractor with half hour visits psychtherapy add on code. If you do 15 min med checks, then i guess, yes, 200/hr can be a going rate.

I have had at least one private offer as a contractor at that rate for 9921*+90833. Heck, I have a CMHC offer for that hourly rate (albeit expecting 60 minute evals/20 minute f/us).
 
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Taddy Mason

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Average starting range in Boston for community attending positions is $220-250K, academic positions are closer to $170K. I have several offers in the midwest post-residency for community and state positions that range between $300-375K for ~50hrs per week and at home call 1-2x per week.
 
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randomdoc1

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Is there 40-60 hours available to work at this rate in Boston?
That and don't forget to factor in quality of life. How flexible is the job? What kind of cases are you dealing with? It can be easy money or super hard money and it comes at a cost too. So glad to have autonomy of one's own practice and getting to do and focus on where your passion is!
 
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Stagg737

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Generally cash payments are higher than insurance reimbursements, with the caveat that they are less consistent as a source of revenue.

That's what the difference actually is. I'd question whether there actually should be a difference at all, but that's a separate conversation. Though idk how much more consistent insurance reimbursements are. Medicare/caid would certainly be more consistent, but I think insurance would depend on the carrier and geographic locations.
 

randomdoc1

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That's what the difference actually is. I'd question whether there actually should be a difference at all, but that's a separate conversation. Though idk how much more consistent insurance reimbursements are. Medicare/caid would certainly be more consistent, but I think insurance would depend on the carrier and geographic locations.
In my experience, insurance is way more consistent payment and client flow. Unless you collect at time of service for cash. But even then, it's not uncommon for patients to not have the money at time of service. Statistically, insurance has been both more the consistent payor and more steady source of income, cash tends to fall off in economic uncerainty.
 

Stagg737

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In my experience, insurance is way more consistent payment and client flow. Unless you collect at time of service for cash. But even then, it's not uncommon for patients to not have the money at time of service. Statistically, insurance has been both more the consistent payor and more steady source of income, cash tends to fall off in economic uncerainty.

I've never seen a cash clinic that didn't collect at time of service or require payment before patient was seen again, so guess I'm just not familiar with other models. Good point about economic uncertainty though, I can see that making things much more difficult.
 
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Monocles

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Average starting range in Boston for community attending positions is $220-250K, academic positions are closer to $170K. I have several offers in the midwest post-residency for community and state positions that range between $300-375K for ~50hrs per week and at home call 1-2x per week.
This number is actually 1-2 years out of date. Friends who are starting at BWH and BI as newly minted attendings next year are 200-210k. Even academia is now bumping up to 200k to stay competitive.
 
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Monocles

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Interesting! I heard Boston is a low-paying market, but things must be different for moonlighting rates?
Boston used to be low. Even 5 years prior when I was still a med student, attendings in the Harvard system were getting ~120-140k for full time academia because they wanted the "harvard name". Many academic attendings make even less (sub 100k) as PART TIME and then roll bank in private practice by advertising as "harvard faculty"
 
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Taddy Mason

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This number is actually 1-2 years out of date. Friends who are starting at BWH and BI as newly minted attendings next year are 200-210k. Even academia is now bumping up to 200k to stay competitive.
The person I got the numbers from said to expect $160-180K as an initial offer but that you could probably negotiate up to low $200K.
 
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JerryMouse

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Boston used to be low. Even 5 years prior when I was still a med student, attendings in the Harvard system were getting ~120-140k for full time academia because they wanted the "harvard name". Many academic attendings make even less (sub 100k) as PART TIME and then roll bank in private practice by advertising as "harvard faculty"
120-140k sounds absolutely miserable. Glad to hear that even the Boston academic institution are offering increased compensation! I wonder what drove the increase in pay when Boston remains as saturated as ever (or so I've heard).
 
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Taddy Mason

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120-140k sounds absolutely miserable. Glad to hear that even the Boston academic institution are offering increased compensation! I wonder what drove the increase in pay when Boston remains as saturated as ever (or so I've heard).
PP market may be saturated, but outside of that definitely not. If anything, like a lot of medicine, more of a maldistribution.
 

Blitz2006

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120-140k sounds absolutely miserable. Glad to hear that even the Boston academic institution are offering increased compensation! I wonder what drove the increase in pay when Boston remains as saturated as ever (or so I've heard).
Yep. But Boston COL ain't cheap either. I hear 1 bedroom to rent (downtown area) is slowly approaching NYC prices..

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Monocles

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Do you find its possible to get telepsych gigs for the evenings? Like being on call for an ED or something similar?
Sadly Mass is one of the most restrictive states in terms of telepsych. Covid has temporarily relaxed some of the restrictions in bigger hospitals and academic institutions, but to the best of my knowledge most locums work is still done in person.
 

Monocles

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120-140k sounds absolutely miserable. Glad to hear that even the Boston academic institution are offering increased compensation! I wonder what drove the increase in pay when Boston remains as saturated as ever (or so I've heard).
This is pure speculation, but in the recent years big locums groups have made really a really aggressive push in recruiting psych residents. Supposedly one group has successfully consolidated "more than half of independent psychiatrists" (however you define that) in the state of Mass. From friends who work for them it is pretty lucrative. Whether or not you agree with them philosophically, one cannot deny that they are driving up pay rates for psychiatrists via bulk negotiations (the company negotiates on docs behalf with big hospitals) and securing these $200/hour contracts.

Of course, Academia (with a big A) is losing out on this deal, so they are forced to respond by increasing their salary in order to retain residents after they graduate.
 
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Stagg737

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Rookie question, but generally it's hard to negotiate academic contracts, correct?

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Generally yes, but can vary significantly. My home program does not negotiate their contracts at all, and if people don't like it they can walk.

Any one heard of $+250 per hour?

Not for telepsych. For non-telepsych I have but not very common and there's usually a good reason they're willing to pay that much.
 

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That's what the difference actually is. I'd question whether there actually should be a difference at all, but that's a separate conversation. Though idk how much more consistent insurance reimbursements are. Medicare/caid would certainly be more consistent, but I think insurance would depend on the carrier and geographic locations.
Generally, insurance patients are more easily referred and generally don't pay much more than what they are expecting to pay based on their insurance (they'll pay a copay or whatever else they need to meet their deductible). They have much less effective income to lose in seeing you, so they are more likely to keep going and feel they are losing money.

Cash patients often already have insurance and are choosing to pay a premium to see you outside of their insurance system, and are more likely to pick you based on your perceived quality or lack of waiting times. Cash patients can always decide to fall back onto insurance or take their business elsewhere if they don't feel you are worth it, so retention in understandably lower than with insurance patients. Cash patients are also more likely to stop going to appointments to save money than an insurance patient. Et cetera...
 
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sluox

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Generally, insurance patients are more easily referred and generally don't pay much more than what they are expecting to pay based on their insurance (they'll pay a copay or whatever else they need to meet their deductible). They have much less effective income to lose in seeing you, so they are more likely to keep going and feel they are losing money.

Cash patients often already have insurance and are choosing to pay a premium to see you outside of their insurance system, and are more likely to pick you based on your perceived quality or lack of waiting times. Cash patients can always decide to fall back onto insurance or take their business elsewhere if they don't feel you are worth it, so retention in understandably lower than with insurance patients. Cash patients are also more likely to stop going to appointments to save money than an insurance patient. Et cetera...

Have you run either a cash or an insurance practice? What you claim is basically false.

Cash patients statistically have much higher retention. The amount of cash someone pays to see a cash psychiatrist (say $200-300 a month out of pocket) is actually not substantial enough to matter for retention. This is a group that has a total yearly income > 100k, which is roughly the top 10-20% of the population.
 
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JerryMouse

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This is pure speculation, but in the recent years big locums groups have made really a really aggressive push in recruiting psych residents. Supposedly one group has successfully consolidated "more than half of independent psychiatrists" (however you define that) in the state of Mass. From friends who work for them it is pretty lucrative. Whether or not you agree with them philosophically, one cannot deny that they are driving up pay rates for psychiatrists via bulk negotiations (the company negotiates on docs behalf with big hospitals) and securing these $200/hour contracts.

Of course, Academia (with a big A) is losing out on this deal, so they are forced to respond by increasing their salary in order to retain residents after they graduate.
Yes that is definitely very lucrative. Great to hear that psychiatrists in MA are benefiting from collective bargaining! Can't say I feel bad for Boston academia when they've kept rates low for so long...haha. What locums groups are these? There are some corporate management groups like TeamHealth making in-roads into psychiatry in certain markets. I wonder if corporate management will be the norm for psychiatry in the future. Not sure how I feel about it because emergency medicine people seem to complain about corporate groups a lot.
 

CalmAndCollected

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Have you run either a cash or an insurance practice? What you claim is basically false.

Cash patients statistically have much higher retention. The amount of cash someone pays to see a cash psychiatrist (say $200-300 a month out of pocket) is actually not substantial enough to matter for retention. This is a group that has a total yearly income > 100k, which is roughly the top 10-20% of the population.
This is based on what a psychiatrist who runs a cash based practice told me. He says it took him decades to build enough of a cash-only patient base for it to make sense to stop taking insurance and how cash based practices are much more competitive compared to insurance based ones, particularly because patients can very easily take their business elsewhere. But this is ultimately an N of 1 in manhattan.

Personally, all the people who make >100k in my circles wouldn’t consider $200-300 a month for a psychiatrist or therapist insubstantial enough to keep paying it if they feel they can better care elsewhere or would get equivalent care from their insurance.
 
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Blitz2006

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If Psychiatrists are making $200/hr in a saturated area like Boston, this is impressive and suggests that mental health is being taken seriously nowadays and reimbursed appropriately.

40 hour week x 48 weeks, puts you close to 400k. Not bad at all for Beantown.

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Somewhat related and rather than making a new thread I'll post it here.

How does time off work when you are doing locums? What if you need a sick day? if you have a long term contract (6-12 months) are you not able to take any vacation/unpaid time off?
 

michaelrack

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Somewhat related and rather than making a new thread I'll post it here.

How does time off work when you are doing locums? What if you need a sick day? if you have a long term contract (6-12 months) are you not able to take any vacation/unpaid time off?

Most locums contracts have a one month out clause... unpaid time off can usually be scheduled at least one month in advance ( but they might say no), it's a matter of negotiation... either side can cancel the contract
 

sluox

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What happens in the event of needing a sick day last minute?

Usually locums goes into a pool, and someone can call out last minute. I remember when I was a resident, once a hospital randomly called me on a weekend morning and was like we have you on our calendar, and I was like my contract with you ended two months ago.

They were able to find someone a couple of hours later. There's always another locums guy who'd be up to getting more shifts.

This is also why getting a 1M contract with one person at one facility is highly unrealistic. They'll have a 1M budget and divide it up for redundancy.
 
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Candidate2017

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Have you run either a cash or an insurance practice? What you claim is basically false.

Cash patients statistically have much higher retention. The amount of cash someone pays to see a cash psychiatrist (say $200-300 a month out of pocket) is actually not substantial enough to matter for retention. This is a group that has a total yearly income > 100k, which is roughly the top 10-20% of the population.

I don't have much personal data about cash practice but based on resident clinic, it seems an insurance practice fills very quickly. Through COVID, I've retained almost all of my regular insurance patients through telepsych. The few I've lost, I'm guessing some lost their jobs, others were relatively new and weren't invested in treatment and would've left regardless. Everyone else keeps returning and they want more frequent visits.

The clinic itself is down in revenue. But that's due to slow moving bureaucracy. I hear everyone else in private practice in the community are booming with visits.
 

budda10000

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I live in the north east and I keep hearing that $200 is the going rate here. I see some people posting rates as $250 up to $290 per hour in the midwest! I want to know what is the trend now days?

Here is an idea for all you "what is the salary" question people... Respond to the job ad's and find out. In three days here is what I found

3 Jobs in California-->hourly wages 185, 200, 195
1 Job in South Dakota-->hourly wage $260
1 Job in Wyoming--->hourly wage $290
1 Job in Michigan---> Hourly wage $210
1 Job in Denver--->hourly wage 190


As you can see there is quite a spectrum. These are all locums gigs.

If you are a real trooper there is a gig waaay up in rural AK that pays something obscene ~700k/year. Special training in bear induced PTSD required.
 
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randomdoc1

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If you are a real trooper there is a gig waaay up in rural AK that pays something obscene ~700k/year. Special training in bear induced PTSD required.
Bear induced PTSD...how do you know the bear doesn't have human induced PTSD? huh?! huh?! Where's their support >.>. I'm sure the bear would have a very different story...Health disparities I tell you.

I hear everyone else in private practice in the community are booming with visits.
Ain't that the truth! On a side note, many of my colleagues who work in healthcare systems, got salary cuts due to covid. Not drastic ones fortunately, but I assume this is the help subsidize other parts of the system that were hit harder with so much closing up. whereas in practice I always had the option to work (and make) more if I wanted. No cuts here. I'm telling you people, PP is the way MD/DO's can get back some of what we deserve: more competitive pay rates, better lifestyle, don't need to supervise mid levels if you don't want to, more practicing autonomy, etc.
 

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Bear induced PTSD...how do you know the bear doesn't have human induced PTSD? huh?! huh?! Where's their support >.>. I'm sure the bear would have a very different story...Health disparities I tell you.
On the topic of Bear health disparities:
I heard a rumor that there are so few Veterinarians in AK they are trying to push through their legislature a scope of practice increase so any licensed health care professional can treat the Bear Lead (Extreme) Endocardial Deficiency (BLEED). Cured by a single lead bolus dose - the BLEED(ing) eventually stops. They are even permitting distance treatments out to 300 yards!
 
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Blitz2006

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Here is an idea for all you "what is the salary" question people... Respond to the job ad's and find out. In three days here is what I found

3 Jobs in California-->hourly wages 185, 200, 195
1 Job in South Dakota-->hourly wage $260
1 Job in Wyoming--->hourly wage $290
1 Job in Michigan---> Hourly wage $210
1 Job in Denver--->hourly wage 190


As you can see there is quite a spectrum. These are all locums gigs.

If you are a real trooper there is a gig waaay up in rural AK that pays something obscene ~700k/year. Special training in bear induced PTSD required.


How many hours a week can you do at these jobs? 20? 40? 60?
 

psyguru

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I am doing $220/hr at an FQHC in Houston. I work one day a week. There are more openings, either PT or FT. Currently providing telepsychiatry. PM me if anyone is interested.
 
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